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For many young athletes, making it onto a college sports team is a dream come true. But medical experts caution that student-athletes are among those most likely to develop bone fractures and organ failures associated with eating disorders. Despite the warnings, eating disorders in sports are a problem that receives little attention, and in some cases, remains ignored by coaches and administrators. Senior investigative reporter Vicky Nguyen reports in a story that first aired Monday February 29, 2016. (Published Monday, Feb. 29, 2016)

College athletes are seen as the picture of health. But the focus, discipline, and competitiveness that creates a successful student-athlete can also fuel a serious health condition with lifelong impacts.

According to the National Eating Disorders Association, student-athletes are among those most likely to develop bone fractures and organ failures associated with eating disorders. But as the NBC Bay Area Investigative Unit learned, it’s a mental health condition that receives little attention, and in some cases, goes ignored by coaches and administrators at major universities.

To see how deep the problem runs in California, the Investigative Unit asked all public Division I and Division II programs (where athletes receive NCAA scholarships) how many student athletes they’ve treated for eating disorders in the last five years. The 28 schools educate nearly 10,000 student athletes each year, but none of the universities had any idea how many student-athletes they’ve treated. Some schools told us they don’t track that information, others said they didn’t refer any students for treatment.

Former University of California, Los Angeles runner Mary Wright believes the prevalence of eating disorders on college teams is a problem that needs more transparency. In 2003, the Soquel High School cross country standout earned a scholarship to compete for the Bruins, achieving a childhood goal.

Nervous about her spot on the roster, Wright looked to a teammate for guidance.

“She was losing weight and then she was running faster. And then you realize that she’s restricting her food completely. And so without really even noticing, I was emulating what she was doing.”

Wright says she was never educated about the dangers of eating disorders and by the end of her freshman year, losing weight became an obsession. So much so, she chose to leave UCLA and began her recovery away from college sports.

“I was self-aware enough to know that it was becoming an issue and my parents knew it was an issue and I just said, you know what – and I was just completely done,” Wright said.

Former University of California, Berkeley soccer player Jennifer Medina says she also began restricting food as a way to improve her spot on the team. But her short term solution led to long term health problems.

“I kind of was just barely functioning,” Medina told NBC Bay Area. “When they did a bone density scan, [it looked like] I was already in my 60s,” Medina described.

When she finally sought help, Medina says her coach wasn’t educated on how to properly handle the situation, and forced her to “out” herself to the entire team.

“He just said ‘Jen, do you have something you want to tell the team?’ Here I am, it was the first time I saw a lot of them in a few months and they could all tell that I dropped significantly and that I do not look good, and I was just mortified,” Medina recalled. “I knew his intentions were right, but his execution was wrong and his execution is not uncommon.”

Now, as a mental health therapist, Medina wants to change the game by providing support to students struggling with eating disorders.

“There is no risk free sport. For guys as well. Out of all mental illnesses, this has the highest mortality rate, this is not a joke,” Medina said.

Both eating disorders and disordered eating (a less severe form of eating disorder) can be difficult to detect and even harder to discuss.

Prevention strategies for coaches and administrators:

1. Be aware of the symptoms of disordered eating ("Coach and Trainer Toolkit")
2. De-emphasize weight: Be aware of how you are communicating to athletes about weight and performance. Focus on ways for athletes to enhance their performance that do not involve weight.
3. Screen student-athletes before the start of the season for risk factors of disordered eating using a validated screening instrument ("NATA Questionnaire", "SCOFF Questionnaire")
4. Consult a registered dietitian who specializes in sports, to prescribe appropriate nutrition for optimal sport performance.
5. Keep an open dialogue with athletes about the importance of nutrition and staying injury-free for optimal athletic performance.

6. Recognize that the body composition and training required for optimal health and performance are not identical for all athletes.
7. Ensure that all stakeholders (coaches, strength and conditioning coaches, athletic trainers, student-athletes, student-athlete affairs administrators, athletics department staff) are educated about the factors that put athletes at risk for disordered eating.
8. Understand your institution’s referral protocol for student-athletes who are in need of assistance with nutrition or disordered eating issues.
9. Encourage help-seeking for all mental health concerns, including disordered eating.
10. Develop a plan with other stakeholders (e.g., university counseling services, sports s RD) for how to identify and treat student-athletes with eating disorders.

But the Investigative Unit’s review of medical history forms found those best practices are often ignored. Out of the 28 California schools that offer NCAA scholarships, at least half a dozen don’t ask any recommended questions about weight and body image.

Pediatrician Jennifer Carlson works with dozens of student athletes as part of the eating disorders care team at Lucile Packard Children’s Hospital. She believes disordered eating is a problem campuses often overlook.

“It is key to have some kind of question where you’re asking about these issues because otherwise they may not come up,” Carlson said. “We have seen athletes who at age 20-21, have fractures that you should not be seeing until someone is more at the age of 50 or 60.”

Carlson is now working on a studying looking at medical history forms for Stanford athletes to determine whether athletes who showed symptoms of disordered eating and malnutrition went on to suffer serious injuries.

“We looked over the course of their college career to see did they sustain any stress fracture or bone injury, so we can say if an athlete had this score, what was their likelihood of developing a stress fracture over their college career,” Carlson explained. The goal is to develop a tool that will help coaches and trainers identify students at risk so they can be treated early.

At San Jose State University, student health center director Roger Elrod says his department has a team dedicated to treating all students with eating disorders, including athletes. For the first time this spring, that team will meet with the entire coaching staff to educate them on the disordered eating signs, symptoms, and preventative measures.

But not all schools are as proactive. Unlike other medical conditions including concussions and sickle cell trait, schools aren’t required to follow best practices for preventing and treating disordered eating. It is left up to each school to address, and as we found in some cases, to ignore.